两种药物联合靶控输注在老年全麻术后镇痛的临床研究

Effects on TCI of remifentanil combined with sufentanil on postoperative pain in elderly patients during anesthesia

目的:探讨瑞芬太尼联合舒芬太尼TCI在老年患者围术期应激反应及术后疼痛方面的临床疗效。方法:将我院收治的104例择期行腹部手术的全麻患者随机分为A组与B组,每组52例。A组给予5ng/mL的瑞芬太尼进行诱导麻醉,4ng/mL麻醉维持,缝合时经静脉患者自控镇痛(PCIA);B组给予2ng/mL瑞芬太尼联合舒芬太尼进行麻醉诱导和维持,缝合时PCIA。比较两组麻醉前(T1)、插管前(T2)、插管后1min(T3)、开腹后1min(T4)和拔管后1min(T5)的收缩压(SBP)、舒张压(DBP)以及心率(HR);记录两组术中血流变动力学剧烈波动次数;比较两组术后4、12、24h的VAS评分以及12、24h的血清皮质醇、血糖以及镇痛药用量。结果:B组各时间点SBP、DBP均低于A组(P<0.01),T2、T3、T4HR均低于A组,差异无统计学意义(P>0.05);B组术中调节次数、各时间点VAS评分、血清皮质醇、血糖以及镇痛药用量均低于A组,差异具有统计学意义(P<0.01)。结论:瑞芬太尼联合舒芬太尼TCI在降低老年患者围术期应激反应及术后疼痛方面的疗效显著,值得进行临床推广。

Objective. To investigate the clinical effects on TCI of remifentanil combined with sufentani in elderly patients during anesthesia. Methods： Totally 104 cases of general anesthesia undergo- ing abdominal operation were randomly divided into group A and B with 52 eases of each group. Group A was given 5 ng/mL of remifentanil for induction of anesthesia, and 4 ng/ml for maintenance of anesthesia, and then received PCIA at skin suture group B was given 2 ng/mL remifentanil and sufentanil for indue tion and maintenance of anesthesia,and then received PCIA at skin suture. At time points including beforeanesthesia （T1）, before intubation （T2）, 1 min after intubation （T3）, lmin after operation（T4） and 1 rain after extubation （TS） of systolic blood pressure （SBP）, diastolic blood pressure（DBP） and heart rate （HR） were compared between the two groups the adverse cardiovascular event, VAS score at 4h, 12h, 24 h, 12h, 24h, postoperative cor, GLu and analgesic dosage were recorded. Results. The SBP, DBP in group B were significantly lower than that in A group（P0.01） at any time point, the HR of T2, T3, T4 were lower than those in group A,but the difference was not significant （P）0.05） the incidence of ad- verse cardiovascular event,VAS scores, cor, GLu and postoperative analgesic dosage of group B were sig- nificantly lower than group A （P〈0.01）. Conclusion： The TCI of remifentanil combined with sufentanil has a satisfactory clinical effects on reducing the perioperative stress response and postoperative pain in the elderly patients, it is worthy of clinical promotion.